notice of intent (noi) / notice of disposal general …notes: 1. applications for disposals to land...
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NOTICE OF INTENT (NOI) / NOTICE OF DISPOSAL
General Permit AKG320000 – Statewide Oil and Gas Pipelines
Please submit this NOI to:
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION Wastewater Discharge Authorization Program
555 Cordova Street Anchorage, Alaska 99501
Submittal of this document constitutes notice that the party identified in Section 3 intends to be covered by the Alaska Pollutant Discharge Elimination System (APDES) General Permit AKG320000 – Statewide Oil and Gas Pipelines (Permit). The Permit authorizes discharges into waters of the United States and disposals to land resulting from construction, operation, and maintenance activities for pipelines and related facilities. The term notice of intent (NOI) refers to an application to discharge to water and the term Notice of Disposal (NOD) refers to an application to dispose wastewater to land. Please provide all information below and attach supplemental information sheets as appropriate.
SECTION 1 – PERMIT INFORMATION
☐New Applicant ☐Existing Permitee Authorization No.: ☐Revision – An existing authorization that requires updates to include new discharges, or new discharge locations (e.g., phased large
Plan of Development).
☐Renewal – An existing authorization that is requested to be administratively extended upon expiration of the GP.
SECTION 2 – PIPELINE INFORMATION Provide pipeline information and define individual pipeline segments for permit authorizations in the fields below. Pipelines may be divided into several project / management segment areas or a single segment for the entire pipeline right-of-way. Pipeline milepost (MP) zero (0) should start from the source of oil or gas (e.g., Gas Treatment Plant) and the terminating milepost should be the end destination (e.g., Liquefied Natural Gas Facility). Check only one box next to the Segment this NOI/NOD request is for.
If this NOI/NOD is submitted to revise or renew an existing authorization, skip to Section 4.
Pipeline Name: ☐ Operation/ Maintenance ☐ Construction
Coordinates at MP 0: Terminating Coordinates:
Latitude: Latitude:
Longitude: Longitude:
Coordinate Source:
Defined Segments Start MP End MP
☐ Segment 1 000.00
☐ Segment 2
☐ Segment 3
☐ Segment 4
☐ Segment 5
☐ Segment 6
☐ Segment 7
☐ Segment 8
SECTION 3 – RESPONSIBLE PARTY INFORMATION Person responsible for overall management of the project.
First Name: Last Name: Title:
Company: Phone: Fax:
E-mail Address:
Mailing Address:
City: State: Zip:
SECTION 4 – ON-SITE CONTACT/OPERATOR INFORMATION ☐Check if same as Responsible Party and skip to Section 7
First Name: Last Name: Title:
Company: Phone: Fax:
E-mail Address:
Mailing Address:
City: State: Zip:
SECTION 5 – NEGOTIATED FEE CONTACT ☐Check if same as Responsible Party and skip to Section 7
First Name: Last Name: Title:
Company: Phone: Fax:
E-mail Address:
Mailing Address:
City: State: Zip:
SECTION 6 – BILLING INFORMATION ☐Check if same as Responsible Party and skip to Section 7
First Name: Last Name: Title:
Company: Phone: Fax:
E-mail Address:
Mailing Address:
City: State: Zip:
SECTION 7 – SUMMARY OF DISCHARGES AND DISPOSALS Complete the table below which summarizes the number of discharges, mixing zones, and disposals requested. Summary Table must match Section 8 and 9 attachments.
Discharges or Disposals Requested How Many Disposal Outfalls to Land? 1,2
How many Discharge Outfalls to Water? 1,2
How many Outfalls will require a Mixing Zone? 3
001 Drilling Fluids and Drill Cuttings 4 N/A
002 Domestic Wastewater N/A N/A
003 Gravel Pit Dewatering 4
004 Excavation Dewatering 4
005 Hydrostatic Test Water N/A
006 Storm Water - Construction N/A N/A
006 Storm Water - Operation N/A N/A
007 Mobile Spill Response N/A
NOTES:
1. Applications for Disposals to land < 500,000 gpd may not be required. See Permit Section 1.1.3. 2. Complete the appropriate outfall forms for each disposal to land and discharge to water and attach under Section 8. 3. Complete the AKG320000 Mixing Zone Attachment for each requested mixing zone and attach under Section 9. 4. If HDD or dewatering activities are within 1,500 feet of a contaminated site listed as active, clean-up complete, institutional controls, or
contaminated groundwater plume contact DEC Contaminated Sites Program (CSP) and check this box. CSP contacted
SECTION 8 – OUTFALL DETAILS Complete and attach AKG320000 – Outfall Forms 001 - 007 for discharges and disposals requested as a part of this NOI.
SECTION 9 – MIXING ZONE REQUESTS Complete and attach AKG320000 - Mixing Zone Form for every mixing zone requested as a part of this NOI.
SECTION 10 – OTHER ATTACHMENTS List additional attachments below. Examples include other Reports or Plans that are not specifically required but support the NOI (e.g., FERC Sediment and Erosion Control Plan).
SECTION 11 – CERTIFICATION
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
Signature Title
Printed Name Date
FILE NUMBER_________________(for DEC use)
NOI SECTION 8 ATTACHMENT
General Permit AKG320000 – Statewide Oil and Gas Pipelines
DISCHARGE 001 – DRILLING FLUIDS AND DRILL CUTTINGS
PROJECT INFORMATION (Same as SECTION 3)
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name (NOI Section 2): Segment No. (NOI Section 2):
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Vicinity Map,
Site Plan, and Plan
and Profile
Included Submit a vicinity map (topographic map or aerial photograph) showing the general location
of all HDD activities included in NOI. Include detailed Site Plans showing drilling sites,
receiving waters, and proposed equipment locations. Provide a plan and profile drawing of
the proposed HDD that includes pertinent geological and hydrogeological information.
Project Description
(for Type A1 Fluids)
Included A description of the method of drilling method, equipment technology used to minimize or
eliminate discharges (i.e., HDD, recirculating), typical design schematics, and BMP measures
taken to minimize the quantity of the water discharged and meet permit requirements.
Project Descriptions for A2 and A3 are included in the DFP. See Fact Sheet Section 3.1.
SPP Data
(for Type A1 Fluids)
Included
N/A
Describe drilling fluid additive that will be used (i.e., bentonite) and include 96hr LC50 SPP
data or analysis results for the product. Fluid mixture data must demonstrate an SPP
concentration of 750,000ppm or greater. See Fact Sheet Section 3.1.
Drilling Fluids Plan
(for Type A2 Fluids)
Included
N/A
Include 96hr LC50 SPP data for each drilling fluid additive (Provide SPP analysis of the
combined toxicity for the fluid mixture containing each additive at the maximum proposed
concentration (See Appendix XX for equation).) All SPP results must be 500,000ppm or
greater. See Fact Sheet Section 3.1.
Drilling Fluids Plan
(for Type A3 Fluids)
Included
N/A
Include 96hr LC50 SPP analysis for each drilling fluid additive and combined mixture
demonstrating results of 500,000ppm or greater. Provide Total Metals analysis for stock
barite using surrogate metals demonstrating values less than 3 mg/kg for Cadmium and 1
mg/kg for Mercury.
Other Reports and
Related Plans
Included Provide copies reports, applications, and plans required by other state or federal agencies
where information may support NOI (e.g., Inadvertent Release Plans).
AKG320000 Mixing
Zone Attachment
Included
QTY.______
Include one Mixing Zone Attachment for each discharge where a 500 ft mixing zone is
requested for turbidity and residues associated with an inadvertent release.
DISCHARGE 001 – DRILLING FLUIDS AND DRILL CUTTINGS ACTIVITIES Provide an inventory all anticipated HDD and Geotechnical Investigation sites included in your NOI application. Attach additional pages if necessary.
Drill Point Entry Location: Estimated Start – End Dates Drilling Fluid Category1 Mixing Zone Requested? 2
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Begin __________________
End __________________
A1
A2
A3
Yes
No
NOTES: 1. See Fact Sheet Section 3.1 for Outfall 001 ‐ Drilling Fluids and Drill Cuttings Characterization for description of drilling fluid categories. 2. Complete AKG320000 ‐ Mixing Zone Attachment form for each discharge requested.
FILE NUMBER_________________(for DEC use)
NOI SECTION 8 ATTACHMENT
General Permit AKG320000 – Statewide Oil and Gas Pipelines
DISCHARGE 002 – DOMESTIC WASTEWATER
PROJECT INFORMATION
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name: Segment No. (NOI Section 2):
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Vicinity Map
and Site Plan
Included Submit a general vicinity map (topographic map or aerial photograph) showing the
general location of all Domestic Wastewater Facilities included in NOI. Include a
detailed Site Plan showing the location (latitude and longitude) of each facility
including the discharge location and the expected discharge flow direction. Provide
the approximate distances from the end of the pipe to any water uses (e.g., water
intakes, fisheries, bathing areas, other discharges, etc.).
Description of
Wastewater
Treatment and
Operation
Included Include all makes, models, and a brief description of the treatment process(es) including the level of treatment (e.g. secondary) and type of disinfection. Describe all disposal methods for any sludge, septage, grit, screenings, and other facility residualsgenerated from the treatment system. Include schematic flow diagram of thewastewater treatment process. For pre‐approved package treatment modules provide design flow of each module and number of modules used at the facility location.
DEC Plan Review Included Submit any DEC Plan Review and Approval to Operate for wastewater treatment
system, if applicable.
Effluent Testing
(Existing Facilities
Only)
Included
Permit #:
If the facility is being relocated from another camp, provide previous DEC permit
authorization or permit number, if applicable. Effluent testing data collected over
the previous 12 months for the following parameters: pH (minimum, maximum),
maximum and average flow rate, BOD5, TSS, fecal coliform bacteria, and total
chlorine residual or the previous 12 instances of monitoring data collected if there
has not been 12 months of data for the previous year.
DISCHARGE 002 – DOMESTIC WASTEWATER Provide an inventory of all anticipated domestic wastewater facilities included in your NOI application. Attach additional pages if necessary.
Discharge Location: Facility Type Approved Treatment Capacity Peak Demand Flow Rate1:
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Stationary Facility
Mobile Camp
Describe2:
Total Design Capacity3: (gpd)
Pre‐Approved Package Treatment Modules Module Unit Design Capacity4: (gpd/unit) Number of Modules Used: x (units) Total Design Capacity2: (gpd)
(gpd)
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Stationary Facility
Mobile Camp
Describe2:
Total Design Capacity3: (gpd)
Pre‐Approved Package Treatment Modules Module Unit Design Capacity4: (gpd/unit) Number of Modules Used: x (units) Total Design Capacity2: (gpd)
(gpd)
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Stationary Facility
Mobile Camp
Describe2:
Total Design Capacity3: (gpd)
Pre‐Approved Package Treatment Modules Module Unit Design Capacity4: (gpd/unit) Number of Modules Used: x (units) Total Design Capacity2: (gpd)
(gpd)
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Stationary Facility
Mobile Camp
Describe2:
Total Design Capacity3: (gpd)
Pre‐Approved Package Treatment Modules Module Unit Design Capacity4: (gpd/unit) Number of Modules Used: x (units) Total Design Capacity2: (gpd)
(gpd)
MP
Latitude: Longitude:
Coordinate Source:
Waterbody Name:
Stationary Facility
Mobile Camp
Describe2:
Total Design Capacity3: (gpd)
Pre‐Approved Package Treatment Modules Module Unit Design Capacity4: (gpd/unit) Number of Modules Used: x (units) Total Design Capacity2: (gpd)
(gpd)
NOTES: 1. Peak Demand is based on maximum camp occupancy and appropriate per capita flow assumptions (typically 75 gpd/cap)
2. Describe treatment system type (e.g., wastewater type, RBC, membrane, other)
3. This is the maximum monthly average flow that will be approved for the system
4. Pre‐approved package treatment modules may be used individually or used in combination to meet Peak Demand Flow Rates
FILE NUMBER_________________(for DEC use)
NOI/NOD SECTION 8 ATTACHMENT
General Permit AKG320000 ‐ Statewide Oil and Gas Pipelines
DISCHARGE/DISPOSAL 003 – GRAVEL PIT DEWATERING
PROJECT INFORMATION (Same as SECTION 3)
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name (NOI Section 2): Segment No. (NOI Section 2):
Note: Land Disposals of less than 500,000 gpd are automatically authorized for Gravel Pit Dewatering necessary
for preexisting pipeline operations and maintenance. See Permit Section 1.1.3.
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Vicinity Map
and Site Plan
Included Submit a vicinity map (topographic map or aerial photograph) showing the general
location of all gravel pit activities included in NOI/NOD. Include a detailed Site Plan
showing the pit to be excavated and any treatment systems. The detailed map must
show the discharge location in the receiving water or land Disposal Area.
Project Description Included A description of the method of dewatering, including typical design schematics, and
measures taken to minimize the quantity of the water discharged as well as a
description of the treatment and control methods that will be used to meet permit
requirements.
DEC Plan Review Included If chemicals or physical treatment systems are proposed, include typical design
schematics and any DEC approvals of the proposed treatment methods and disposal
methods. See Fact Sheet Section 6.1.2.1.
Other Reports and
Related Plans
Included Provide copies reports, applications, and plans required by other state or federal
agencies where information may support the NOI/NOD).
AKG320000 Mixing
Zone Attachment
Included
QTY.______
Include one Mixing Zone Attachment for each discharge which may require a 500 ft
mixing zone for turbidity and residues resulting from Gravel Pit Dewatering
Discharges.
DISCHARGE/DISPOSAL 003 – GRAVEL PIT DEWATERING Provide an inventory all anticipated gravel pit dewatering sites included in your NOI application. Attach additional pages if necessary.
Location Effluent Destination: Mixing Zone1
Flow Rate2 Describe Treatment3
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
NOTES:
1. Complete AKG320000 ‐ Mixing Zone Attachment form for each Mixing Zone requested.
2. For gravel pits with large daily discharge volumes where sediment and erosion control issues cannot be managed by BMPs, or the limits cannot be attained at the boundary of a single mixing zone, the applicant may
request multiple discharge locations with separate mixing zones. In this case complete a separate section for each outfall.
3. Some chemicals and treatment or disposal methods may require a plan submittal prior to adoption in BMP Toolkit (i.e. mechanical treatment packages, flocculants, coagulants, etc.).
FILE NUMBER_________________(for DEC use)
NOI/NOD SECTION 8 ATTACHMENT
General Permit AKG320000 ‐ Statewide Oil and Gas Pipelines
DISCHARGE/DISPOSAL 004 – EXCAVATION DEWATERING
PROJECT INFORMATION (Same as SECTION 3)
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name (NOI Section 2): Segment No. (NOI Section 2):
Note: Land Disposals of less than 500,000 gpd are automatically authorized for Excavation Dewatering necessary for
preexisting pipeline O&M. See Permit Section 1.1.3.
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Scope Map
and Site Map
Included Submit a general site map (topographic map or aerial photograph) showing the
general location of all excavation activities included in NOI. Include a detailed map
showing the site to be excavated and location of sedimentation ponds, if applicable.
The detailed map must show the location of the receiving water or area of land
discharge.
Project Description Included A description of the method of dewatering, including typical design schematics, and
measures taken to minimize the quantity of the water discharged as well as a
description of the treatment and control methods that will be used to meet permit
requirements.
DEC Plan Review Included A description of the method of dewatering, including typical design schematics, and
submit proof of DEC Plan Review and Approvals of pretreatment methods (not
required for energy depletion devices or sedimentation ponds without chemical
additions).
Other Reports and
Related Plans
Included Provide copies reports, applications, and plans required by other state or federal
agencies where information may support NOI/NOD.
AKG320000 Mixing
Zone Attachment
Included
QTY.______
Include one Mixing Zone Attachment for each discharge which may require a 500 ft
mixing zone for Turbidity and Residues resulting from Excavation dewatering
discharges.
DISCHARGE/DISPOSAL 004 ‐ EXCAVATION DEWATERING Provide an inventory all anticipated excavation dewatering sites included in your NOI application. Attach additional pages if necessary.
Location: Effluent Destination
Mixing Zone 1
Flow Rate / Estimated Volume Total 2 Describe Any Treatment 3
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land
Discharge to Waterbody
Name:
Yes
No
Max Discharge (Pump) Rate: (gpd)
Estimated Daily Volume: (gpd)
Volume: (gal)
NOTES:
1. Complete AKG320000 ‐ Mixing Zone Attachment form for each Mixing Zone requested.
2. For gravel pits with large daily discharge volumes where sediment and erosion control issues cannot be managed by BMPs, or the limits cannot be attained at the boundary of a single mixing zone, the applicant may
request multiple discharge locations with separate mixing zones. In this case complete a separate section for each outfall.
3. Some chemicals and treatment or disposal methods may require a plan submittal prior to adoption in BMP Toolkit (i.e. mechanical treatment packages, flocculants, coagulants, etc.).
FILE NUMBER_________________(for DEC use)
NOI/NOD SECTION 8 ATTACHMENT
General Permit AKG320000 ‐ Statewide Oil and Gas Pipelines
DISCHARGE/DISPOSAL 005 – HYDROSTATIC TEST
PROJECT INFORMATION (Same as SECTION 3)
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name (NOI Section 2): Segment No. (NOI Section 2):
Note: Land Disposals of less than 500,000 gpd are automatically authorized for Hydrostatic Tests necessary for preexisting
pipeline O&M. See Permit Section 1.1.3.
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Vicinity Map
and Site Plan
Included Submit a vicinity map (topographic map or aerial photograph) showing the general
location of hydrostatic test activities included in NOI. Include a detailed map
showing the hydrostatic test site. The detailed map must show the location of the
receiving water or area of land discharge.
Project Description Included A description of hydrostatic test method, including volume estimates and measures
taken to minimize the quantity of the water discharged as well as a description of
the treatment and control methods that will be used to meet permit requirements.
DEC Plan Review Included If a large volume of hydrostatic test water is to be disposed to an area that will
require evaluation of infiltration capacity, a plan submittal may be required.
Other Reports and
Related Plans
Included Provide copies reports, applications, and plans required by other state or federal
agencies where information may support NOI/NOD.
DISCHARGE/DISPOSAL 005 ‐ HYDROSTATIC TEST Provide an inventory all anticipated hydrostatic test sites included in your NOI application. Attach additional pages if necessary.
Activity Location: Effluent Destination Has pipe been exposed to hydrocarbons? 3
Flow Rate / Volume Describe proposed treatment, if applicable.
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land 1
Discharge to Waterbody 2
Name:
Yes
No
Max Daily: (gpd)
Average Mo: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land 1
Discharge to Waterbody 2
Name:
Yes
No
Max Daily: (gpd)
Average Mo: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land 1
Discharge to Waterbody 2
Name:
Yes
No
Max Daily: (gpd)
Average Mo: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land 1
Discharge to Waterbody 2
Name:
Yes
No
Max Daily: (gpd)
Average Mo: (gpd)
Volume: (gal)
MP
Latitude:
Longitude:
Coordinate Source:
Disposal to land 1
Discharge to Waterbody 2
Name:
Yes
No
Max Daily: (gpd)
Average Mo: (gpd)
Volume: (gal)
NOTES: 1. Some chemicals with treatment and disposal to land may be approved on a case‐by‐case basis via a plan submittal.
2. The use of chemicals such as biocides or antifreeze are prohibited. See Permit Section 2.6.4.
3. Hydrostatic testing on new unused oil and gas pipelines are assumed to contain no hydrocarbons. A pipeline, tank, or other vessel that previously carried hydrocarbons, may be required to undergo additional monitoring
prior to discharging to water to ensure limits are met (see Permit Section 2.6.1).
FILE NUMBER_________________(for DEC use)
NOI SECTION 8 ATTACHMENT
General Permit AKG320000 ‐ Statewide Oil and Gas Pipelines
DISCHARGE 006 – STORM WATER/CONSTRUCTION
PROJECT INFORMATION (Same as SECTION 3)
Applicant: Phone:
Contact Person: Fax:
E‐mail Address:
Mailing Address: City:
Borough or Similar Government Subdivision: State: AK Zip:
Project name and Segment number:
Beginning Latitude and Longitude or Mile Post: Ending Latitude and Longitude or Mile Post:
PROJECT INFORMATION (If applicable per Fact Sheet Section 5.3.3.1)
Co‐Applicant: Phone:
Contact Person: Fax:
E‐mail Address:
Mailing Address: City:
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Project Scope Vicinity
Map and Site Plans
Included Submit a vicinity map (topographic map or aerial photograph) showing the general
location of all construction storm water areas to be included in NOI. Include
detailed site plans showing initially proposed storm water discharge locations as
well as interrelated discharges for gravel pit and excavation dewatering, and
hydrostatic test. The detailed site plans must show the location of receiving waters
and land disposal areas that may impact, or be impacted by, storm water.
Initial Project SWPPP
and Certification
Included Submit initial SWPPP with the first NOI for DEC files. For revisions to existing
authorizations, submit a certification that the SWPPP has been revised and is
ready for implementation..
Equivalent Plans
Consistency
Certification
Included Per Fact Sheet Section 10.4, federally required sediment and erosion control plans
(e.g., FERC Sediment and Erosion Control Plans) may be accepted as equivalent to a
SWPPP if developed to be consistent with the Permit. Submit certification with the
NOI that the equivalent plan is consistent with Permit requirements.
FILE NUMBER_________________(for DEC use)
NOI SECTION 8 ATTACHMENT
General Permit AKG320000 ‐ Statewide Oil and Gas Pipelines
DISCHARGE 006 – STORM WATER/OPERATION
PROJECT INFORMATION (Same as SECTION 3)
Applicant: Phone:
Contact Person: Fax:
E‐mail Address:
Mailing Address: City:
Borough or Similar Government Subdivision: State: AK Zip:
Project name and Segment number:
Beginning Latitude and Longitude or Mile Post:
Ending Latitude and Longitude or Mile Post:
FACILITY OR FACILITIES (For Multiple Facilities, See Fact Sheet Section XX)
Facility Name or Multi‐Facility Description:
Facility Location Description:
List of Facilities in Multi‐Facility Description:
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Vicinity Map and Site
Plans
Included Submit a vicinity map (topographic map or aerial photograph) showing the
general location of all facilities to be included in NOI. Include detailed individual
site plans showing each facility, other facility related discharge locations,
infrastructure layout, areas of potential contamination, and flow directions. To
obtain multi‐facility coverage, the facilities must be proximal and have an
operational nexus that allows for the responsible party to implement the SWPPP
per the Permit.
Initial SWPPP and
Subsequent
Certifications
Included Submit initial SWPPP with the first NOI for DEC files. For revisions to existing
authorizations, submit a certification that the SWPPP has been revised and is
ready for implementation.
FILE NUMBER_________________(for DEC use)
NOI/NOD SECTION 8 ATTACHMENT FORM
General Permit AKG320000 ‐ Statewide Pipeline Activities
DISCHARGE/DISPOSAL 007 – MOBILE SPILL RESPONSE
PROJECT INFORMATION (Same as SECTION 3)
First Name: Last Name: Title:
Company: Phone: Fax:
E‐mail Address:
Mailing Address:
City: State: Zip:
Pipeline Name (NOI Section 2): Segment No. (NOI Section 2):
CHECKLIST – ADDITIONAL NOI REQUIREMENTS
Discharge/Disposal of contaminated Spill Response water requires use of an approved treatment process/system adopted in the
BMP Toolkit. If the volume of treatment required is greater than 500 gpd, plan submittals may be required.
DISCHARGE/DISPOSAL 007 – MOBILE SPILL RESPONSE
Effluent Destination 1 Describe Treatment Package 2
Disposal to land
Discharge to Water
NOTES: 1. Select both options if seeking flexible permit coverage. 2. A description of the process or treatment system used to remove free‐phase and dissolved phase hydrocarbons. Process/systems must be approved for use in the
BMP Toolkit.